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European Heart Journal Advance Access originally published online on April 28, 2009
European Heart Journal 2009 30(14):1703-1710; doi:10.1093/eurheartj/ehp160
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population

Xavier Jouven1,2,3,4,10,*, Peter J. Schwartz5,6,7,8,9, Sylvie Escolano1,3,4,10, Céline Straczek1,3,4,10, Muriel Tafflet1,3,4,10, Michel Desnos2,3, Jean Philippe Empana1,3,4,10 and Pierre Ducimetière1,3,4,10

1 INSERM, Unit 909, Cardiovascular Epidemiology and Sudden Death, Hopital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
2 Department of Cardiology, European Georges Pompidou Hospital, Paris, France
3 University Paris Descartes, Paris, France
4 IFR 69, Paul Brousse Hospital, Villejuif, France
5 Section of Cardiology, University of Pavia, Pavia, Italy
6 Fondazione Policlinico S. Matteo, Pavia, Italy
7 Laboratory of Cardiovascular Genetics, IRCCS Instituto Auxologico Italiano, Milan, Italy
8 University of Stellenbosch, Stellenbosch, South Africa
9 University of Cape Town, Rondebosch, South Africa
10 Paris Cardiovascular Research Center@HEGP, Unit 970, Paris, France

Received 10 February 2009; revised 20 March 2009; accepted 20 March 2009; online publish-ahead-of-print 28 April 2009.

* Corresponding author. Tel: +33 1 56 09 36 87, Fax: +33 1 56 09 26 64, Email: xavier.jouven{at}egp.aphp.fr

Aims: The aim of this study involves the early identification, among apparently healthy individuals, of those at high risk for sudden cardiac death. We tested the hypothesis that individuals who respond to mild mental stress in preparation for exercise test with the largest heart rate increases might be at highest risk.

Methods and results: Data from 7746 civil servants participating in the Paris Prospective Study I, followed-up for 23 years, allowed to compare heart rate changes between rest and mild mental stress (preparation prior to an exercise test) between subjects who suffered sudden cardiac death (n = 81), non-sudden (n = 129) coronary death, or death from any cause (n = 1306). The mean heart rate increase during mild mental stress was 8.9 ± 10.8 b.p.m. Risk of sudden cardiac death increased progressively with heart rate increase during mental stress and the relative risk of the third vs. the first tertile was 2.09 (95% confidence interval, 1.13–3.86) after adjustment for confounders. This relationship was not observed for non-sudden coronary death.

Conclusion: An important heart rate increase produced by a mild mental stress predicts long-term risk for sudden cardiac death. Heart rate changes before an exercise test may provide a simple tool for risk stratification.

Key Words: Sudden death • Heart rate • Risk factors • Epidemiology • Population study


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